Against my more rational urges, I recently joined Twitter. After all, I’m blogging now, so it was only a matter of time before the other shoe dropped. I signed on, added a little profile, linked it to Skeptic North, and started following a few people. Tweeted once, then again, and then once more. I was really rolling.

But then something unexpected happened — a complete stranger followed me, one Dr. Isaac Eliaz. I checked his profile, which described him as an “Integrative Holistic Medical Doctor.” Ahh, I thought, he must have seen my tweet about Dr. Mercola’s anti-aspartame rant on HuffPo. Apparently, that’s what happens when you add @mercola to a tweet. Anyway, I was happy to have someone from the alt-med community following me, and who knows, maybe something I say will cause him to question his practices. Not likely I suppose, but I’m an optimist.

Just as I was about to close the window and get back to my day, I caught Dr. Eliaz’s latest tweet out of the corner of my eye, advising his 600 followers about “Research on new prostate formula that naturally combats #prostatecancer!“ Clearly, I had to know more, so I clicked the website link in his Twitter profile.

Serious academic credentials mean serious research, right? Well, perhaps. Dr. Katz is head of Columbia’s Center for Holistic Urology, which “offers the best of conventional and alternative medicine to men and women with urinary tract disorders including prostate, bladder, and kidney cancers, chronic urinary tract infections, benign prostatic enlargement, prostatitis, incontinence, interstitial cystitis, and kidney stones.” But we can’t dismiss him just because he’s a partisan — after all, most research is done by individuals with depth in a specific field, and natural medicine is no different. So let’s take a look at the study itself.

Now I’m no cancer researcher, so I’m not going to come at this the same way the folks at SBM might. I’m going to start with the things that got my skeptical bells ringing, then make such comments on the substance of the study as befit my level of expertise. To those readers with a deeper medical background, please feel free to give the study a read and add your thoughts in the comments.

So why am I hungry for yogurt? Perhaps it’s that “novel integrative blend of vitamins, minerals, multiherb extracts, and derivatives”. Mmm, delicious. From the opening sentence, this paper reads like a product brochure, and I’m instantly skeptical. It continues:

ProstaCaid is a 33-ingredient comprehensive polyherbal preparation with supplements of vitamin C, vitamin D3, zinc, selenium, quercitin, 3,3′-diinodolymethane (DIM), and lycopene. Herbal extracts include the extracts from turmeric root, saw palmetto berry, grape skin, pomegranate, pumpkin seed, pygeum bark, sarsaparilla root, green tea, and Japanese knotweed. Hence, it is rich in natural polyphenols, including quercetin, resveratrol, epigallocatechin gallate (EGCG), and ellagic acid, which have previously demonstrated anticancer potential. The unique formula contains 3 medicinal mushrooms grown on an herbal-enhanced medium. The mushrooms included are Phellinus linteus, Ganoderma lucidum, and Coriolus versicolor, each with known anticancer properties. Therefore, ProstaCaid was designed based on constituents that exhibit antiprolifetaive, antioxidant, and apoptotic activities; however, its efficacy and the mechanisms of action are yet to be examined.

On reading this passage, I was reminded of one of the pithier quotes I heard in business school, about the marketing successes of the free-range movement: “It’s not the eggs, it’s the story of the chicken”. In this case, it’s the story of the mushrooms. And the framing — “ProstaCaid was designed”, “rich in natural polyphenols”, “unique formula” — goes well beyond a clinical description of the product.

Further down, he tells us that, “ProstaCaid is manufactured consistent with the FDA Good Manufacturing Practices regulation for dietary supplements as defined in 21 CFR§111, for batch-to-batch consistency and quality control.” Again, more of a marketing bullet than clinically relevant information. By this point, I’m actually a bit disappointed they haven’t mentioned that they’re a family-owned company with a stellar BBB rating.

There’s more, but I think you get the point, so let’s turn to the research itself, which Dr. Eliaz tells us establishes ProstaCaid as a “potent natural formula “ that “can be crucial in the fight against prostate cancer.” Must have saved lot of people, right? No? Saved a lot of mice?

Try a lot of cells — it’s a test-tube study. Does that mean it’s invalid? Of course not, but here’s what the Canadian Cancer Society says about such studies:

Preclinical Trials

New drugs or treatment approaches are often tested first on animals or live human cells in test tubes. Scientists identify an approach that is most likely to succeed, and then carry out preliminary research into safety and effectiveness.

It’s not unusual for a potential treatment to appear promising at this early stage of research. But it’s usually hard to know if a new cancer treatment will work in humans until it has passed through 3 phases of clinical testing.

Preclinical trials are important, in that they identify potential areas of further research. But they’re hardly sufficient for recommending a course of treatment, especially for something as deadly as prostate cancer. And Dr. Eliaz does overtly recommend such treatment on his site:

As an integrative physician with extensive experience in the treatment of prostate cancer, I have witnessed many patients recover with a combination of integrative and natural therapies to boost immunity and directly attack the disease. Based on the latest peer-reviewed research on the most powerful cancer-fighting botanical compounds, I have developed a comprehensive prostate formula that targets prostate cancer and promotes healthy prostate cells, while also supporting overall health. Learn about this prostate health breakthrough…

Wait, what? That link goes to the ProstaCaid page on EcoNugenics.com. Which turns out to be Dr. Eliaz’s company, and which sells a one month supply of ProstaCaid for a mere $157.45. OK, so it’s all falling into place now. There’s just one missing piece…

Oh, there it is, at the end of the research paper:

Acknowledgments

The authors would like to thank Dr Isaac Eliaz for his contribution to the study and for developing the formula

. . .

Funding

The author(s) disclosed receipt of the following financial support for the research and/or authorship of this article: this work was supported by a sponsored research grant from EcoNugenics, Inc, Santa Rosa, CA.

Now the researchers do state that they have no conflicts of interest, and I have no evidence to suggest otherwise. The fact that Dr. Eliaz’s company paid for the research doesn’t necessarily mean anything unethical is going on. But combined with the marketing-like language in the study and Dr. Eliaz’s overreaching claims about the therapeutic value of a treatment that hasn’t even entered staged trials, I’m going to go out on a limb and suggest prostate cancer patients get a second opinion. The claims here may look scientific, but they fall neatly into a category I like to call scientiferous — just scientific enough to sound impressive.

I’ll let you decide whether you think they’re also deceptive, but in the meantime: buyer beware.

26 Responses to “Scientiferous Treatments for Prostate Cancer”

I think you did an excellent skeptical review of the study, so no need to be apologetic about not up to SBM’s standards. I think you’ve shown that one needn’t not have specific knowledge about a topic…in this case medicine..in order to be able to analyze and critically deconstruct it.

Unfortunately, there are a lot of quacks out there who happen to have obtained an MD somewhere along the way. I recall a fellow in medical school, whose only interest was in getting his MD and then go into acupuncture for sports injuries. He was smart enough to get through…but what a waste to the public education system that heavily subsidizes doctors educations.

I work with doctors who believe in nonsense like Healing Touch, Acupuncture, Emotional Freedom Technique and The Rosen Method who otherwise seem like smart people…except when it comes to their pet “woo”.

Tim, you’re so right – education and expertise are no guarantee of a reason-based approach. Plus, I suspect many physicians, after listening to multiple patients espouse the virtues of some or other bit of woo, end up unconsciously receptive. Often it only takes a few anecdotes that something works to trigger the availability heuristic, which is associated with various errors of probabilistic reasoning. As they say often over at SBM, the three most dangerous words in medicine are “In my experience…”

The Townsend Letter December 2010 p40-43 published an outline of
The Amitabha Medical Clinic and Healing Center approach
to Prostate Cancer. Dr. Isaac Eliaz is one of the principles.
His Prostacad formula is used and, from a layman’s view he has incorporated many of the bits and pieces of the herbal treatment landscape in one formula, much to the boon(we hope) of anyone with prostate cancer for which it is appropriate. I’m looking to buy time an aging 94 year old dad for whom no standard treatments are real options. While Prostacad is not a cure, it looks like it might be a good time buying therapy. Of course the jury will be out for years to come. I always hate the “promotional nature” of so many therapies, and I commend Erik for his careful and balanced critique of how he encountered the promotion of Prostacad. When,at 94, you are going to die with prostate cancer within 2 or 3 years anyway what therapy does one choose? We’d sure like something that might lengthen one’s useful life even if that time will be short.

Thanks for the link. I’ve just skimmed it so far, but it looks like another test tube study, so doesn’t really change much. Promising? Sure, maybe, but let’s talk when there have been some clinical trials.

This study was supported by a research grant from EcoNugenics, Inc., Santa Rosa, CA. We would like to thank Barry Wilk for his contribution to this study. One of the authors, I. Eliaz, acknowledges his interest as the formulator and owner of EcoNugenics, Inc.

I was diagnosed with prostate cancer in December of 2003. I have refused all conventional treatments because I wanted to have a life. I have been taking various supplements and for a short time (less than six months) Avodart. Last December my PSA was 32. Then I started taking ProstaCaid at the recommended doses. In March, my PSA was 26. Coincidence or the placebo effect? I doubt it, for I have tried many things I thought would work, but did not. Is it ProstaCaid together with other things I have been taking over the years? Maybe, probably.
As far as the promotion is concerned I do not disagree with you. But is it any worse than the commercials on TV? They tell you how wonderful a drug is and then list six or more potential side effects, some time even mentioning lethal. And what about doctors being paid by the pharmaceutical companies to write “scientifically valid” papers in medical journals? I have been Katz’s patient for two years and he practices more conventional medicine than alternative/holistic medicine. I did not find him to be the kind of man who would be a tool of a business’ interest.
I do have a number of major complaints about supplements and alternative medicine. First, I think some supplements are priced way too high. So are synthetic drugs, but at least some of the cost is covered by insurance. One of my sons is suffering from a very rare disease and because it effects very few people there are no drugs available to him. He managed to get an appointment at the NIH and spent a whole day with six doctors. At the end of the day they could not offer him anything. Being a scientist he researched everything he could find. After years of looking he finally found a doctor who was willing to work with him, essentially commenting on my son’s own research findings. One of the drugs that they though should be tried costs $1 million per gram. And, insurance would not pay for it.
I wish that there was some way to reel in prices of both drugs and supplements. The last thing I would like to see is the FDA taking control; this is a long story for another time.
The second major bitch I have with the alternative world is their approach. What your doctor wouldn’t tell you… etc. This is nothing more than a turf war as to who can dominate the marketplace and make the most money. On the other hand, conventional doctors will call everybody a quack who does not fall in their line. There is no question that both camps have a lot to offer. Conventional medicine’s diagnostic tools are fantastic. Drugs, especially cancer drugs, can do more damage to one’s body than the disease itself. Natural therapies and supplements at times work better than anything else. Why can’t the two sides declare peace and work together?
Let me end this by asking another question. People whose life expectancy is the longest are in Japan. Two years ago I listened to a radio program and found out that a hospital stay in Japan costs $10 a day. While it is very low, but why do we have to pay up to $1,000 a day in this country? If somebody can answer that, please do.

Tom, I’m glad to hear that your situation is under control, and it’s certainly not my place to second guess your decisions. As a general statement though, I’d just point out that conventional prostate cancer treatments are now resulting in a 96% 5 year survival rate – see http://www.statcan.gc.ca/pub/82-003-x/2011002/article/11425/tbl/tbl1-eng.htm. While I can understand the desire to avoid the side-effects associated with those treatments, I’m not sure I’d make the same decision given just how good the odds are. Faced with pancreatic cancer though, I might well agree with you.

On the costs — I assume you’re writing from the US, since in Canada we typically don’t pay for hospitalization directly. I personally don’t understand why the US is so resistant to socialized healthcare given the broadly equivalent outcomes in both systems, except to say that they typically set the fulcrum point between individual freedom and social obligation closer to the former than we (and much of Europe) do. Every society has to set their own balance, but to be perfectly honest, that’s one of the reasons I chose to live here, rather than in the States where I was raised.

Your review is helpful. I wish you had a little greater understanding of some of the basic issues with cancers such as prostate cancer. There are some good studies that are suggestive of the validity of the Prostacaid approach. We know that certain cancers can be supported by intake of exogenous substances. We know that everyone has cancer cells everyday, but that natural systems keep the cancer cells from becoming a serious disease in individuals. Ultimately some cancers, like prostate cancer and breast cancer, may be cancers we can live with. The secret may be to control the cancer through diet and hormone control.

I just had brachytherapy for prostate cancer late last year. I am not quite as skeptical as you and I believe that the choice of the NIH to do further studies on Prostacaid, shows that they see some merit to the research. NIH personnel are probably better judges of the merits of studies on Prostacaid to this point. If a researcher has a material of promise, should they keep things quiet, or should they promote the material?
In the days of really lousy funding by our government, should researchers fund their own research through capitalistic methods.

There are many more good studies on the positive effect of certain exogenous chemicals on cancers like prostate cancer thank you seem to realize.

I’m only responding to what Dr. Eliaz is claiming as evidence for his product. So far, all I’ve seen is test tube studies, which are simply insufficient to base a treatment on — and it’s not me saying this, it’s the Cancer Society.

That said, I have no particular beef with this product, other than the fact that its evidence base doesn’t match its marketing claims. If that evidence base has evolved since I wrote this, I’d be happy to look at more recent studies – just provide the references.

Thanks Bob. This is still another in-vitro study, so it doesn’t change my assessment. The fact is, the vast majority of promising treatments at the pre-clinical stage don’t hold up in subsequent clinical trials — there’s a long way to go from test tube to real medicine for humans.

For now, when my father’s disease progresses, I’d consider ordering ProstaCaid pills, even if there is no real evidence that they work good in humans. Well, I’d actually consider “Active hemicellulose compound (AHCC)” (quote from the study I linked above), but not sure that herb is available in pill form in sufficient dosages anywhere.

Bottom line, we are having new drugs for late stage prostate cancer introduced every few months nowadays. But they just work for a few months and then stop working. I believe some of these herbs are really worth trying.

I can’t access the full paper, but from the abstract, it’s clear that it’s a single case report. One 66 year old man (sample size n=1), with no control group. It shows somebody improved after taking AHCC, not that they improved because they took AHCC. The authors *hypothesize* that there might be relationship, but that’s pretty far from evidence of efficacy.

It’s not my place to tell you how to manage your father’s care, but two things that I’d encourage you to consider as you make treatment decisions:

The first is that conventional prostate cancer treatments have a 96% 5 year survival rate. That’s a very high bar for any alternative treatment.

The second is that it’s very easy to mistake positive early-stage research findings like the ones posted here for more than they are. The simple fact is that most research published, even in peer-reviewed journals, is false. This is typically due to small sample sizes, poor study design, and (occasionally) the financial interests of the researchers or their backers. Papers like these can end up being shiny objects that distract patients from proven treatments — especially when the people heralding them have something to sell you.

One crucial element of scientific discourse that seems to get missed in communicating with the public is the meaning and purpose of peer-reviewed research. That a paper is published in a peer-reviewed journal is often perceive as the paper definitively answering a question. In actual fact, papers are published because publishers and reviewers felt that the paper somehow added to current discussion on the relevant topic. The paper MAY provide a very good answer to a question, but those papers are few and far between. More often than not, each paper is part of a larger puzzle and may agree or disagree with overall consensus based on a number of factors, most often simply study design.

You show just how ignorant you are when you talk about prostate cancer having a 96% 5 year survival rate. That is a totally worthless fact and is being expressed by a person that knows little of nothing of prostate, the survival statistics, and disease progression. Here is a fact: when men fail a primary treatment protocol, such as surgery or radiation, there is NO proven medical cure…none. Check that fact. However, you can fail primary treatment and live for 10, 15 years or longer. Prostate cancer is a very slow progressing cancer. However your options are lousy. Drugs such as Avodart, Lupron and Proscar that mess with hormones and have horrific side effects. Newer drugs such a provenge cost $100,000 and are only available when you have failed all other treatment and there are no further options. And then, Provenge only extends life a few mere months.

I am not sure of your objectives here…you sound like a bitter person. But as an individual that failed their primary treatment for metastatic prostate cancer when diagnosed at age 45 I know far more about both the disease and treatment options than you do.

As far as prostacaid is concerned, I am not saying it works. But the flip side of the coin is that every drug that turns out to be successful also had promising in-vitro studies.

So what is your true motive here? Are you somehow connected with the pharmaceutical industry? Who are you trying to help?

It is simply the case that the majority of potential therapies tested in their early stages don’t translate into meaningful clinical therapy (see for example the classic Ioannidis paper on the subject).

So IMO the skepticism and caution recommended by the likes of Erik is optimal when confronted with marketing claims that go beyond what the evidence supports.

Also, I’m sorry to say your personal experience, however unfortunate, does not grant you the authority to dismiss cancer survival rates from StatsCan as “worthless”.

Mark, as I’ve said to others here, it’s not my place to second guess anyone’s treatment decisions. All I’ve attempted to do is show why the claims that the manufacturer is making aren’t supported by the available evidence. Individuals of course have the right to ignore that fact and choose their own course of treatment, but I do hope that I’ve caused at least a few readers to question Prostacaid’s claims.

That’s not because I’m connected with the pharmaceutical industry or have some ulterior motive — I’m not and I don’t — but because I find it reprehensible for companies to take advantage of the critically ill by making unsupported clinical claims.

A pharmaceutical company couldn’t get away with this type of behaviour because there is a regulatory structure in place to protect the consumer. It’s not perfect and it sometimes fails, but it attempts to ensure that the evidence bar is much higher and the penalties for bad faith much steeper.

For natural treatments though, the consumer is left to his or her own devices and it’s extremely difficult to call shady companies to account. The best defence therefore is honest skepticism, which is what I’ve attempted here.

Abstract:
We have recently demonstrated that the dietary supplement ProstaCaid™ (PC) inhibits growth and invasive behavior of PC-3 human prostate cancer cells in vitro. In the present study, we evaluated toxicity and whether PC suppresses growth of prostate cancer in a xenograft model of human prostate cancer cells implanted in mice. Here, we show that an oral administration of PC (100, 200 and 400 mg/kg) did not affect body weight or activity of liver enzymes (ALT, AST) and did not show any sign of toxicity in liver, spleen, kidney, lung and heart tissues in mice. In addition, PC treatment resulted in the inhibition of tumor volumes (1024.6±378.6 vs. 749.3±234.3, P<0.001) in a xenograft model of prostate cancer with human hormone refractory (independent) PC-3 prostate cancer cells. Moreover, qRT-PCR analysis demonstrated significant upregulation of expression of CDKN1A (p21) and inhibition of expression of IGF2, NR2F2 and PLAU (uPA) genes by an oral administration of PC in prostate cancer xenografts. Our study demonstrates that the concentrations of the dietary supplement ProstaCaid tested did not show signs of toxicity, and its oral application has significant anticancer activity in vivo and can be considered as an alternative treatment for prostate cancer patients.

I appreciate this discussion. Mark K. is absolutely correct in that there is no cure if your PC returns after surgery and radiation. You are now in a waiting game where you are given hormone treatment as long as that work, and then you follow up with chemo. (which also doesn’t work).
So the prognosis is more than lousy. I’m in the middle of this myself and I can attest that with the odds stacked the way they are you are pretty vulnerable when you read about some new ‘miracle’ cure. ‘I will leave no stone unturned is the mantra in my household’.
I have, however, had to learn to take a more cynical view. There are just too many people out there who are only interested in your money. I wish I could be more comfortable with the ProstaCaid claims.

After reading all of the comments I have this to say. Eric thanks for your input. I am being treated for prostate cancer, using an alternative approach. my number was 8.3 when I started the treatment. Over a period of 10 months it went down to 2.1 I started to feel bullet proof and deviated from the strict dietary schedule and in 7 months it went back up to 7. My fault, not the procedure.
And as for the 95% five year survival rate for conventional treatment that is a medical lie. They are playing with numbers. It looks like a longer survival rate. What they don’t say is that cancers are be found earlier then they were 10 or 15 years ago because of new diagnostic methods so they can say see our chemo and radiation and surgery works.
As for myself well I am just going to get fanatical with my alternative treatment and start following the procedure to the letter.
If you follow the directions alternative medicine works Eric.

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Erik is a technology professional based in Toronto, focused on the intersection of the internet and the traditional media and telecommunications sectors. A reluctant blogger, he was inspired by the great work Skeptic North has done to combat misinformation and shoddy science reporting in the Canadian media, and in the public at large. Erik has a particular interest in critical reasoning, and in understanding why there’s so little of it in the public discourse.
You can follow Erik's occasional 140 character musings @erikjdavis